评估血清Tenascin-C作为急性主动脉夹层动脉瘤患者生物标志物的临床研究

Clinical study on evaluating serum Tenascin-C as a biomarker in patients with acute aortic aneurysm/dissection

目的肌腱蛋白C(Tenascin-C,TNC)与心血管疾病的不良预后和重大心血管事件的发生有关。本研究旨在评估TNC在作为急性主动脉夹层动脉瘤(AAD)生物标志物方面的价值。方法回顾性纳入2021年5月至2022年3月于新疆维吾尔自治区人民医院心脏及泛血管医学诊疗中心心脏外一科接受治疗的120例AAD患者(AAD组,Stanford A型或B型,均在突发疼痛症状后24 h内入院),另选同时期107例颈动脉狭窄(CAS)患者作为CAS组,120例健康志愿者作为正常对照组。术前、急诊开胸手术后第1、3、7、14 d检测AAD组患者血清TNC水平,与另外两组血清进行比较。主要研究终点为术后60 d短期生存结局。结果与正常对照组相比,AAD组患者术前血清TNC水平显著升高(P<0.001),且StanfordA型患者术前血清TNC水平较B型患者更高(P<0.05)。术后第3 d,AAD组患者血清TNC水平较术前下降(P<0.05),术后第14 d时与正常对照组比较,差异无统计学意义[119.26(71.31,157.14)pg/ml vs.117.83(84.04,134.07)pg/ml,Z=-0.873,P=0.383]。与正常对照组比较,CAS组患者血清TNC水平显著升高(P<0.001),且与颈动脉狭窄程度呈正相关(r=0.279,P=0.004)。根据受试者工作特征曲线,术前血清TNC预测AAD的曲线下面积(AUC)为0.731;预测CAS的AUC为0.671。血清TNC可良好区分AAD患者和CAS患者,AUC为0.816。23例AAD患者术后60 d内死亡,根据术前血清TNC水平ROC曲线临界值(172.74pg/ml)分层,AAD患者的短期生存率与术前血清TNC水平有关(logrank=3.706,P=0.047)。结论血清TNC水平可作为急性主动脉夹层动脉瘤潜在的诊断和预后生物标志物。

Objective Tenascin-C(TNC)is associated with poor prognosis of cardiovascular disease and the occurrence of major cardiovascular events.Methods Retrospective inclusion of data from 120 AAD patients(AAD group)(Stanford type A or B,all admitted within 24 hours of sudden pain symptoms)who received treatment at the Department of Cardiology and Extravascular Medicine Diagnosis and Treatment Center of Xinjiang Uygur Autonomous Region People's Hospital from May 2021 to March 2022.All patients were admitted within 24 hours after sudden pain symptoms.In addition,107 patients with carotid artery stenosis(CAS)and 120 healthy volunteers were selected as CAS group and normal control group.The serum TNC level of AAD group was detected before surgery and at 1,3,7 and 14 days after emergency thoracotomy surgery,and the serum TNC level of CAS group and normal control group were compared.The primary endpoint was short-term survival outcomes at 60 days after surgery.Results Compared with the normal control group,patients in the AAD group showed a significant increase in perioperative serum TNC levels(P<0.001).Moreover,the serum TNC level of Stanford type A patients at admission was higher than that of type B(P<0.05).The serum TNC levels of patients in the AAD group significantly decreased on 3rd day after surgery compared to perioperative TNC level(P<0.05),and there were statistically significant differences on 3rd day,7th day,and 14th day after surgery(P<0.05).Moreover,there was no statistically significant difference in serum TNC levels between the 14th day after surgery and the normal control group(P=0.383).Compared with the normal control group,the serum TNC levels of patients in the CAS group significantly increased(P<0.001),and was positively correlated with the degree of carotid artery stenosis(r=0.279,P=0.004).The area under the curve(AUC)of perioperative serum TNC for predicting AAD was 0.731,and the AUC for predicting CAS was 0.671.Most importantly,serum TNC could effectively distinguish between AAD and CAS patients,with an AUC of 0.816.23 AAD patients died within 60 days after surgery.Stratified according to the threshold value of ROC curve of perioperative serum TNC level(172.74 pg/mL),the short term survival rate of AAD patients was related to perioperative serum TNC level(log rank=3.706,P=0.047).Conclusion Serum TNC level can serve as a potential diagnostic and prognostic biomarker for AAD,and it is recommended to comprehensively evaluate this indicator in clinical practice to improve prognosis.